Pre-auth Non Clinical Consultant

2 weeks ago

Pretoria, Gauteng, South Africa 3SixtyHealth (Pty) Ltd Full time

3Sixty Health has a great opportunity for a suitably qualified individual to fulfil the advertised position and join their team.


3SIXTY HEALTH 3Sixty Health is a black owned and managed, reputable and a major player in driving South African economy by investing in ''black excellence''3Sixty Health is 100% black owned and black managed administrator. It is

BACKGROUND accredited by the council for medical schemes to offer both administration and managed care services, allowing for a fully integrated, beneficiary-centric approach. Our core competencies in administration include membership management, billing, claim adjudication and customer services.

It is a medical aid administrator of Sizwe Hosmed Medical Scheme.

POSITION Pre-Auth Non Clinical Consultant

DIVISION Managed Health Care

DEPARTMENT Hospital Utilization

JOB PURPOSE

LOCATION Head Office (Johannesburg)

DUTIES AND RESPONSIBILITIES

  • Validation of membership and benefits availability according to Preauthorisation policies and procedures
  • Authorisation of procedures and admission to hospital based on medical necessity
  • Contact relevant suppliers regarding acceptance or denial of authorisation within 24 hours prior to admission
  • Source appropriate information to resolve issues
  • Record all authorisations and queries handled
  • Prepare cases for review by the medical advisor
  • Identify and document patients with chronic conditions
  • Fostering relationships with staff at assigned hospitals to improve coordination of care at appropriate levels;
  • Handling of queries effectively and efficiently.
  • Ensure proposed clinical procedures and length of stay are appropriate
  • Provide patients with preoperation instructions
  • Adhere to Call Centre standards of above 97% calls answered
  • Meet call Centre daily targets according to company service level agreements
  • Adhere to workflow standard according to policies and procedures
  • Oversee the intercompany transactions lead internal intercompany confirmations on a quarterly basis
  • Attendance of finance meetings in order to provide insights and strategic analysis on the financial health of the
Group

QUALIFICATIONS

  • Matric
  • Registered/ enrolled nurse ( with SANC) with 3 years relevant nursing experience in the Medical Aid sector
  • Computer Literate
  • Proficiency and fluency in English and another official language
  • Excellent Telephone Manner
  • Good communication and interpersonal skills with customer focus.
  • Previous Preauthorisations experience would be advantageous
  • Sound knowledge of Prescribed Minimum Benefits
  • Sound knowledge of National Reference Price list remove
  • Basic knowledge of ICD 10 and CPT coding

CORE COMPETENCIES

  • Ability to work under pressure and as part of a Team
  • Willingness to work overtime when necessary
  • Enthusiasm to accept and develop in a changing environment
  • Attention to detail and accuracy
  • Professional
  • Able to take responsibility and use own initiative
  • Assertive
  • Goalorientated

Job Type:
Temporary

Ability to commute/relocate:

  • Gauteng, Gauteng: Reliably commute or planning to relocate before starting work (required)

Application Question(s):

  • Do you have the following?
Sound knowledge of Prescribed Minimum Benefits?

  • Sound knowledge of National Reference Price list remove
?

  • Basic knowledge of ICD 10 and CPT coding
?

Are you a Registered/ enrolled nurse ( with SANC) with 3 years relevant nursing experience?

Education:

  • High School (matric) (required)

Experience:

  • Nursing: 3 years (required)

Language:

  • Do you have good communicational skills in English? (required)
Application Deadline: 2023/01/29

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